Hemiepiphysiodesis Of the Proximal Portion of The Femur for The Management of Hip Dysplasia in Children with Cerebral Palsy

Abstract: Objectives: To evaluate the efficacy and safety of proximal femoral hemiepiphysiodesis (PFH) in the management of hip dysplasia in children with cerebral palsy (CP), by means of a systematic review with meta-analysis. Methodology: A systematic review was conducted according to the PRISMA guidelines. Clinical studies investigating PFH in children with CP, with or without a control group, were included. The search was carried out in PubMed, Embase, Scopus, Web of Science and Cochrane Library, with no language or date restrictions. The primary outcomes included the progression of femoral migration (Reimers index), the need for subsequent surgery and complications related to the procedure. The quality of the studies was assessed using instruments appropriate to the methodological design, and the data was synthesized using meta-analysis. Results: Three studies were included, totaling 84 patients. The meta-analysis showed a significant reduction in the Reimers migration index after HPF (mean difference: -5.91%; 95% CI: -10.55 to -1.27; p < 0.01). The rate of need for subsequent surgery was 24% (95% CI: 14%-38%), while the rate of complications was 18% (95% CI: 11%-29%). The overall quality of the studies ranged from moderate to high. Conclusion: Proximal femoral hemiepiphysiodesis has been shown to be effective in containing femoral migration in children with cerebral palsy, with acceptable rates of complications and reoperations. These findings support its use as a less invasive alternative in the management of hip dysplasia in this population.